Rinshō shinkeigaku = Clinical neurology
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An 86-year-old woman was admitted following generalized seizure. Postictally she showed disturbance of consciousness, right hemiparesis, and right spatial neglect. Brain fluid attenuated inversion recovery (FLAIR) imaging demonstrated mainly left-sided, but asymmetrical, subcortical white matter lesions. ⋯ Cerebral amyloid angiopathy-related leukodystrophy was therefore diagnosed and immunosuppressive treatment was started. After 14 days of treatment, clinical symptoms and results of FLAIR imaging were significantly improved. When patients display asymmetrical subcortical white matter lesions with microbleeds on T(2)* weighted imaging, amyloid angiopathy-related inflammation should be considered.
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Case Reports
[Case of Lemierre syndrome associated with infectious cavernous sinus thrombosis and septic meningitis].
A 33-year-old man was admitted to our hospital because of right exophthalmos, diplopia and left neck pain. Neurological examination revealed lateral and inferior disturbance of his right eye movement and the meningeal irritation sign. Cerebrospinal fluid showed elevated polynuclear cells. ⋯ However, after his discharge, he was required re-antibiotics therapy because of septic embolus- induced multiple lung abscesses. Lemierre syndrome is characterized by disseminated abscesses and thrombophlebitis of the internal jugular vein after infection of the oropharynx. Because Lemierre syndrome is potentially life-threatening, early diagnosis and initiation of appropriate therapy are important.
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Epilepsy is a chronic neurological disorder characterized by recurrent seizures that are caused by abnormal and excessive cerebral neuronal discharges. The clinical symptoms are paroxysmal, and may include impaired consciousness and/or motor, sensory, autonomic, or psychic events. Diagnosis of epilepsy is not always straightforward and clear-cut. ⋯ In real situations, however, it is rare for physicians to actually witness the event of seizure. This lecture provides valuable opportunity to experience "real life" clinical diagnosis of epileptic seizures by showing the video of patient under seizure and EEG data. Representative visual examples of symptoms together with the detailed medical knowledge will greatly enhance the capability of diagnosis, the effectiveness of treatment, and help develop clinical strategies.
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Intracerebral hemorrhage (ICH) is a common stroke subtype in Japan. Hypertension is the leading cause. Perindopril Protection Against Recurrent Stroke Study (PROGRESS) revealed that blood pressure (BP) lowering could reduce stroke recurrence by 28% (ICH recurrence by 49%). ⋯ Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT) and Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) showed the feasibility and safety of early rapid BP lowering to 140 mm Hg. INTERACT2 and ATACH II are the randomized trials to compare the guideline-based control (<180 mm Hg) and strict control (<140 mm Hg). We have just started to enroll patients to ATACH II from Japan on February 2012.
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Secondary encephalitis (encephalopathy) causally related with immune response induced by infection, etc., includes encephalitis mediated by innate immunity and adaptive immunity. In the latter, encephalitis mediated by antibodies to molecules at cell-surface of neuron seems to have relatively better outcome. In patients with encephalitis mediated by antibodies to NMDA-type glutamate receptors (NR), mean onset age is 26.5 years old, and the major initial symptoms are limbic symptoms including abnormal behavior, etc. ⋯ In patients with encephalitis mediated by antibodies to voltage-gated potassium channel (VGKC), predominant affection of males are observed, and antibodies to leucine-rich glioma-inactivated 1 (LGI1) and contactin-associate protein (CASR) 2 are found as major epitopes. Patients with Hashimoto encephalitis mediated by antibodies to n-terminal of α-enolase (NAE) have broad spectra of clinical characteristics. Antibodies to TPO can be the marker for diagnosis, and thereafter, confirmation of antibodies to NAE is necessary for definitive diagnosis.